Pharmacy PA Contacts
Toll-free: 877-537-0722
Fax: 877-537-0720
Mississippi Medicaid Prescribers
Registered Users
If you are a Mississippi Medicaid prescriber, submit your prior authorization requests through the Change Healthcare provider portal.
As of October 1, 2016, all providers should re-register at the following link to submit prior authorization requests:
Those Without Web Portal Access
For Mississippi Medicaid prescribers who are unable to submit prior authorizations through the Envision web portal, fax your request to:
Change Healthcare MS Medicaid Pharmacy PA Unit
Fax: 877-537-0720
Drug Prior Authorization Instructions
| Prior Authorization Packets | Updated |
|---|---|
| Brand Name Multi-Source | 5/5/2017 |
| Early Refill | 5/5/2017 |
| Enteral Nutrition | 5/5/2017 |
| EPSDT – Beneficiaries Under 21 | 5/5/2017 |
| Heterozygous Familial Hypercholesterolemia (HeFH) – REPATHA™ (EVOLOCUMAB) and PRALUENT® (ALIROCUMAB) | 5/5/2017 |
| HeFH with ASCVD – REPATHA™ (EVOLOCUMAB) and PRALUENT® (ALIROCUMAB) | 5/5/2017 |
| Hepatitis C Therapy | 5/5/2017 |
| Homozygous Familial Hypercholesterolemia (HoFH) – REPATHA™ (EVOLOCUMAB) | 5/5/2017 |
| Max Unit Override | 5/5/2017 |
| Multiple Concurrent Antipsychotics for Beneficiaries (Age < 18) | 5/15/2017 |
| PDL Exception Request | 5/5/2017 |
| RSV-SYNAGIS® | 10/1/2017 |
Pharmacy Reconsideration Request Form
